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Part 30

In such cases as do not admit of bandaging according to any of the methods which have been described, or which will be described, great pains should be taken that the fractured part of the body be laid in a right position, and attention should be paid that it may incline upward rather than downward. But if one would wish to do the thing well and dexterously, it is proper to have recourse to some mechanical contrivance, in order that the fractured part of the body may undergo proper and not violent extension; and this means is particularly applicable in fractures of the leg. There are certain physicians who, in all fractures of the leg, whether bandages be applied or not, fasten the sole of the foot to the couch, or to some other piece of wood which they have fixed in the ground near the couch. These persons thus do all sorts of mischief but no good; for it contributes nothing to the extension that the foot is thus bound, as the rest of the body will no less sink down to the foot, and thus the limb will no longer be stretched, neither will it do any good toward keeping the limb in a proper position, but will do harm, for when the rest of the body is turned to this side or that, the bandaging will not prevent the foot and the bones belonging to it from following the rest of the body. For if it had not been bound it would have been less distorted, as it would have been the less prevented from following the motion of the rest of the body. But one should sew two balls of Egyptian leather, such as are worn by persons confined for a length of time in large shackles, and the balls should have coats on each side, deeper toward the wound, but shorter toward the joints; and the balls should be well stuffed and soft, and fit well, the one above the [p. 198]ankles, and the other below the knee. Sideways it should have below two appendages, either of a single or double thong, and short, like loops, the one set being placed on either side of the ankle, and the other on the knee. And the other upper ball should have others of the same kind in the same line. Then taking four rods, made of the cornel tree, of equal length, and of the thickness of a finger, and of such length that when bent they will admit of being adjusted to the appendages, care should be taken that the extremities of the rods bear not upon the skin, but on the extremities of the balls. There should be three sets of rods, or more, one set a little longer than another, and another a little shorter and smaller, so that they may produce greater or less distention, if required. Either of these sets of rods should be placed on this side and that of the ankles. If these things be properly contrived, they should occasion a proper and equable extension in a straight line, without giving any pain to the wound; for the pressure, if there is any, should be thrown at the foot and the thigh. And the rods are commodiously arranged on either side of the ankles, so as not to interfere with the position of the limb; and the wound is easily examined and easily arranged. And, if thought proper, there is nothing to prevent the two upper rods from being fastened to one another; and if any light covering be thrown over the limb, it will thus be kept off from the wound. If, then, the balls be well made, handsome, soft, and newly stitched, and if the extension by the rods be properly managed, as has been already described, this is an excellent contrivance; but if any of them do not fit properly, it does more harm than good. And all other mechanical contrivances should either be properly done, or not be had recourse to at all, for it is a disgraceful and awkward thing to use mechanical means in an unmechanical way.

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